POS0611 THE SIGNIFICANCE OF DETERMINING THE LEVEL OF THE ST-2 MARKER OF HEART FAILURE IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: L. Feiskhanova, D. Abdulganieva
Journal: Annals of the Rheumatic Diseases (2022)

Background The heart failure in patients with rheumatoid arthritis differs in its genesis from that in the general population. It has been established that the increased risk of congestive heart failure in patients with RA cannot be explained by the high frequency of risk factors for cardiovascular diseases, including coronary heart disease. While 80% of chronic heart failure in the general population is associated with classical risk factors for cardiovascular diseases, in RA these same predictors explain only 40% of cases Objectives to establish the prevalence of diastolic dysfunction of preclinical signs of heart failure in patients with rheumatoid arthritis. Methods The 282 patients with verified rheumatoid arthritis were examined, including 240 women and 42 men. All patients underwent standard diagnostic tests, two-dimensional transthoracic echocardiography with tissue dopplerography of the myocardium, determination of the level of ST-2, stimulating growth factor, a marker of heart failure, in blood serum. Results The Tissue Dopplerography in combination with two–dimensional echocardiography allowed us to identify patients with diastolic myocardial dysfunction and form the following subgroups. 1 – with normal heart geometry and without diastolic myocardial dysfunction (91 people), 2 – with normal heart geometry and with diastolic dysfunction (45 people), 3 - with structural and geometric remodeling of the heart and without diastolic myocardial dysfunction (73 people), 4 – with structural -geometric remodeling of the heart and with diastolic dysfunction (73 people). Among patients with altered heart geometry (3rd and 4th subgroups), the prevalence of diastolic dysfunction was higher than among those with normal geometry (1st and 2nd subgroups): 50% and 33.1%, respectively (p=0.004). We conducted a comparison between the subgroups depending on the presence of diastolic myocardial dysfunction. The average age of patients with rheumatoid arthritis who showed signs of diastolic dysfunction with normal heart geometry was higher (54 [49; 57] years) than in the compared subgroup (45.5 [33.5; 53.5]) (p&lt;0.0001). They also had significantly higher levels of the ST-2 marker, which indicates an early preclinical sign of heart failure: 70.1 [39.5; 106.5] and 42.2 [29.6; 61.5]ng/ml (p&lt;0.01). Apparently, despite the absence of cardiac remodeling, with age, patients with rheumatoid arthritis are more likely to develop not only diastolic dysfunction, but also diastolic type of heart failure. Conclusion Thus, in patients with rheumatoid arthritis, it is advisable to conduct tissue Dopplerography in addition to standard echocardiography to detect diastolic dysfunction, which in these patients may develop in the absence of structural and geometric changes. References [1]Gabriel S.E. Heart disease and rheumatoid arthritis: Understanding the risks. Annals of the Rheumatic Diseases. 2010 Jan;69 Suppl 1(0 1):i61-64. doi: 10.1136/ard.2009.119404. [2]Sherif F. Nagueh, Otto A. Smiseth, Christopher P. Appleton et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European Heart Journal - Cardiovascular Imaging, Volume 17, Issue 12, December 2016, Pages 1321-1360. doi.org/10.1093/ehjci/jew082. [3]Pascual-Figal DA, Ordoñez-Llanos J, Tornel PL et al. Soluble ST2 for predicting sudden cardiac death in patients with chronic heart failure and left ventricular systolic dysfunction. J Am Coll Cardiol. 2009 Dec 1;54(23):2174-9. doi: 10.1016/j.jacc.2009.07.041. Disclosure of Interests None declared